MEDICARE: AGM RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54489	OTHER	CA	BOARD OF PHARMACY PERMIT

General Provider Information

NPI Number	:	1699775205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGM RX INC

Provider Business Mailing Address
First Line	:	12043 RIVERSIDE DR.
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3744
Country	:	US
Telephone Number	:	818-308-7538
Fax Number	:	818-308-6991

Provider Business Practice Location Address
First Line	:	12043 RIVERSIDE DR.
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3744
Country	:	US
Telephone Number	:	818-308-7538
Fax Number	:	818-308-6991

Authorized Official
Title or Position	:	PRESIDENT/CEO/OWNER
Name	:	MRS. LUSINE MARDYAN
Credential	:
Telephone Number	:	818-308-7538

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	12/20/2019

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